There are a lot of misconceptions about ADHD (Attention Deficit Hyperactivity Disorder) presentation and neurological differences as compared to neurotypical brains. ADHD is fundamentally a dopamine disorder – namely ADHD brains are starved of dopamine. People tend to think of ADHD as a lack of motivation or poor intelligence; rather than a scientific classification of a dopamine disorder.
Presentation
In youth academic settings ADHD is often thought of as an indicator of poor performance. While this may be true, it is also entangled with the development circumstance of each individual – people tend to mature developmentally at different rates; so academic performance often self resolves. This is also demonstrated in the statistics between ADHD diagnosis in children vs. adults; where adults simply “outgrew” their ADHD presumably. Another interpretation of this finding is that perhaps the children are over diagnosed.
In high intelligence (gifted) children, and adults, ADHD is masked due to normal to high academic performance while still exhibiting the behavioral issues caused by ADHD.
1. High IQ May “Mask” the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naïve Adults With ADHD
Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.
https://pubmed.ncbi.nlm.nih.gov/25359760/
So if performance may not indicate ADHD, what does? Again, it is a dopamine disorder, not an indication of motivation or academic performance. ADHD is not the same as IQ or depression; however, ADHD and other disorders often have comorbidities.
2. Understanding Attention-Deficit/Hyperactivity Disorder From Childhood to Adulthood
Anxiety often confounds the diagnosis and treatment of ADHD 3, 11, 12. High rates of the various anxiety symptoms exist in ADHD and may manifest as social, generalized or panic-like symptoms. Similarly, ADHD increases the likelihood of having a depressive disorder by at least two-fold 8, 14. Interestingly, recent data suggest that stimulant treatment of ADHD over time may decrease the ultimate risk for anxiety and depressive disorders 15.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724232/
Comorbidity with Anxiety / Depression
The comorbidity of anxiety and depressive disorders in ADHD cases may explain why some types of anti-depressants are able to help with the treatment of ADHD. Note that depression/anxiety can also be dopamine related; which may explain why SSRI (serotonin) anti-depressants are not found effective in treating ADHD symptoms.
3. A comparative analysis of antidepressants and stimulants for the treatment of adults with attention-deficit hyperactivity disorder
Antidepressants: The range of positive responders was 0% to 75%. Desipramine, bupropion, venlafaxine and tomoxetine appeared to be equally effective and fluoxetine and sertraline [SSRI] produced no response.
https://www.ncbi.nlm.nih.gov/books/NBK67960/
The Science of ADHD
4. Prescription Stimulants Affect People With ADHD Differently
for people who do not have ADHD, stimulants flood the brain with dopamine, causing a dopamine overload.
https://archives.drugabuse.gov/blog/post/prescription-stimulants-affect-people-adhd-differently
Stimulant response for ADHD brains is where neurotypical people seem to get defensive. If a stimulant improves performance for an ADHD brain, why wouldn’t it also improve performance for a neurotypical brain? Doesn’t a stimulant make an ADHD brain more alert?
From this positron emission tomography (PET) scan, you can see how natural dopamine levels are different in people with and without ADHD. The scan on the left shows the brain of someone without ADHD, and the scan on the right shows the brain of someone with ADHD. The greater concentration of yellow, orange, and red in the nucleus accumbens in the scan on the left reflects a higher amount of dopamine.
ADHD brains are dopamine starved. When you add dopamine to an ADHD brain, it has a relaxing effect as it approaches a neurotypical dopamine level – some people even need to take a nap.
5. Why Does Adderall Make Me Sleepy When It Makes Others More Alert?
Adderall is an amphetamine, which generally makes people energetic. However, it has a calming effect for people with ADHD. This calming effect can make some people sleepy.
https://www.healthline.com/health/adderall-makes-me-tired#sleepiness
I’ll give some first hand accounts to help clarify the “relaxing effects” of stimulants for neurotypical people reading this:
If I drink a cup of coffee, I’ll have to poop just like everyone else; but, I won’t feel more alert from the beverage. In fact, the more coffee I drink, the more tired I get, until I inevitably have to take a nap. The nap isn’t something I take from a caffeine crash, it is something I take at the peak caffeine level. I become more awake and alert after the caffeine crash.
If I take Adderall, which is literally amphetamine salts, I need to over-compensate the dosage. This is why titration is important when treating ADHD. When I first started taking Adderall I could not help but take a nap it made me so sleepy. After researching further I found that in order to stay awake I had to over-dose the Adderall to peak the dopamine above neurotypical levels. So if I over-consume Adderall I can stay awake while taking it, but it’s still very relaxing.
From my personal experience stimulants like Adderall are not a good treatment for my ADHD; Ritalin is much better for focus and motivation.
Stimulants as Performance Enhancers
If a neurotypical brain that already has plenty of dopamine function takes a stimulant, they become hyper. This is why many people use stimulants as diet pills or performance enhancers.
6. Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects
Oddly, the assumption that prescription stimulants are truly “cognitive enhancers” is not really questioned. Stimulants reduce hyperactivity, impulsivity, and inattention in children and adults with ADHD, so it has been assumed that these drugs enhance long-term intellectual performance.
These data suggest that when people are given rote-learning tasks their performance is improved by stimulants. The benefits were more apparent in studies where subjects had been asked to remember information for several days or longer. However, studies only found a correlation with rote memory tasks, not complex memory, which is more likely to appear on college exams.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/
I would also note that I have been treating my ADHD with stimulants for years now and have only “taken as needed” and never even approached 1/3rd of a maximum dose of any ADHD treatment medication. My dopamine problems also prevent addictive behavior because I don’t get much of a boost from any type of drug or behavior. I have picked up and stopped cold turkey every addictive drug I have used intermittently.
For example I’ve used nicotine on and off to help with social anxiety or boring social situations – up to what would equal a pack of cigarettes in a day, back to one cigarette in a day, or zero in a day. I have never felt “a craving” for nicotine no matter what dose I have consumed. This is not a continuous habit – something I have done on and off every few years.
The same goes for drinking alcohol – I have consumed an entire case of beer in a day, or several bottles of wine; and just stopped shortly after. I never felt “a craving”. Every type of addictive substance I have encountered I have never had a single urge or craving for. I’m not sure if this can be chalked up to ADHD or something else – but it’s definitely dopamine related, or lack there of. Without a strong reward, an addictive behavior is not addictive.
Summary
For neurotypical people who abuse stimulants, it may offer a marginal performance enhancement, or perhaps a weight loss goal; however, stimulants are highly addictive (think methamphetamine).
For a neurotypical person with normal dopamine levels, a stimulant brings on a high or euphoria. For someone with ADHD a stimulant is a relaxant that brings neurotypical levels of dopamine for a short period of time while getting a task done.
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